citalopram hydrobromide

10 mg, 10 mg/5 mL, 20 mg, 20 mg/10 mL, 30 mg, 40 mg — Tablet

ANTIDEPRESSANTS

Also known as: citalopram hydrobromide oral CITALOPRAM HYDROBROMIDE CAPS 30MG citalopram hydrobromide soln 10mg/5ml, 20mg/10ml; tabs 10mg, 20mg, 40mg citalopram hydrobromide caps 30mg; soln 10mg/5ml, 20mg/10ml; tabs 10mg, 20mg, 40mg citalopram hydrobromide tab 10 mg (base equiv), 20 mg (base equiv), 40 mg (base equiv) CITALOPRAM HBR CELEXA citalopram hydrobromide tab 10 mg (base equiv), 20 mg citalopram hydrobromide soln 10mg/5ml, Citalopram Hydrobromide Oral Tablet Citalopram Hydrobromide Oral Solution citalopram hydrobromide caps 30mg; soln
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Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: CMS QHP JSON  ·  Formulary date: Sep 22, 2026  ·  Checked: 7 hours, 22 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Premier + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 7 hours, 22 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Basic Option 2026 Tier 1 - Generic — — — None
BCBS Federal Focus 2026 Tier 1 - Generic — — — None
BCBS Federal Standard Option 2026 Tier 1 - Generic — — — None
Source: PDF  ·  Formulary date: Oct 7, 2026  ·  Checked: 7 hours, 22 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect myDiabetesCare Silver
via CITALOPRAM HBR 		Tier 1 - Preferred Generic — — ✓ QL
Connect myDiabetesCare Bronze
via CITALOPRAM HBR 		Tier 1 - Preferred Generic — — ✓ QL
Connect Bronze 6500 Indiv Med Deductible
via CITALOPRAM HBR 		Tier 1 - Preferred Generic — — ✓ QL
Connect Silver 5000 Indiv Med Deductible
via CITALOPRAM HBR 		Tier 1 - Preferred Generic — — ✓ QL
Connect Silver RD 5000 Indiv Med Deductible
via CITALOPRAM HBR 		Tier 1 - Preferred Generic — — ✓ QL
Connect Silver 3600 Indiv Med Deductible
via CITALOPRAM HBR 		Tier 1 - Preferred Generic — — ✓ QL
Connect Bronze 7000 HSA Indiv Med Deductible
via CITALOPRAM HBR 		Tier 1 - Preferred Generic — — ✓ QL
Connect Silver 3000 Indiv Med Deductible
via CITALOPRAM HBR 		Tier 1 - Preferred Generic — — ✓ QL
Connect Silver RD 2200 Indiv Med Deductible
via CITALOPRAM HBR 		Tier 1 - Preferred Generic — — ✓ QL
Connect Gold 1500 Indiv Med Deductible
via CITALOPRAM HBR 		Tier 1 - Preferred Generic — — ✓ QL
Connect Bronze RD 6000 Indiv Med Deductible
via CITALOPRAM HBR 		Tier 1 - Preferred Generic — — ✓ QL
Connect Bronze RD 5000 Indiv Med Deductible
via CITALOPRAM HBR 		Tier 1 - Preferred Generic — — ✓ QL
Connect Bronze 5500 Indiv Med Deductible
via CITALOPRAM HBR 		Tier 1 - Preferred Generic — — ✓ QL
Connect Silver RD 3500 Indiv Med Deductible
via CITALOPRAM HBR 		Tier 1 - Preferred Generic — — ✓ QL
Connect Gold CMS Standard
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ QL
Connect Bronze CMS Standard
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ QL
Connect Silver CMS Standard
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ QL
Connect Silver RD CMS Standard
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ QL
Connect Gold RD CMS Standard
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ QL
Connect Bronze RD CMS Standard
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ QL
Source: CMS QHP JSON  ·  Formulary date: Sep 16, 2026  ·  Checked: 7 hours, 22 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AARP Medicare Advantage from UHC NC-0012 (HMO-POS) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) Tier 1 - Preferred Generic — — — None
Longevity Health Plan (HMO I-SNP)
via CITALOPRAM HBR 		Tier 1 - Preferred Generic — — — None
UHC Dual Complete NC-V001 (HMO-POS D-SNP) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0015 (HMO-POS) Tier 1 - Preferred Generic — — — None
UHC Dual Complete NC-S3 (HMO-POS D-SNP) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-24 (HMO-POS) Tier 1 - Preferred Generic — — — None
UHC Complete Care NC-25 (HMO-POS C-SNP) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-26 (HMO-POS) Tier 1 - Preferred Generic — — — None
UHC Complete Care NC-27 (HMO-POS C-SNP) Tier 1 - Preferred Generic — — — None
UHC Complete Care NC-28 (HMO-POS C-SNP) Tier 1 - Preferred Generic — — — None
Alignment Health Platinum (HMO) Tier 1 - Preferred Generic — — ✓ 45 per 30 days QL
Alignment Health NC Duals (HMO-POS D-SNP) Tier 1 - Preferred Generic — — ✓ 45 per 30 days QL
Alignment Health smartHMO (HMO) Tier 1 - Preferred Generic — — ✓ 45 per 30 days QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 1 - Preferred Generic — — ✓ 45 per 30 days QL
Alignment Health Platinum Select (HMO) Tier 1 - Preferred Generic — — ✓ 45 per 30 days QL
PruittHealth Premier (HMO I-SNP)
via CITALOPRAM HBR 		Tier 1 - Preferred Generic — — ✓ 600 per 30 days QL
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via CITALOPRAM HBR 		Tier 1 - Preferred Generic — — ✓ 600 per 30 days QL
Liberty Medicare Dual Plan (HMO D-SNP)
via CITALOPRAM HBR 		Tier 1 - Preferred Generic — — ✓ 600 per 30 days QL
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 1 - Preferred Generic — — ✓ 45 per 30 days QL
DEVOTED CORE 001 NC (HMO) Tier 1 - Preferred Generic — — — None
DEVOTED GIVEBACK 002 NC (HMO) Tier 1 - Preferred Generic — — — None
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) Tier 1 - Preferred Generic — — — None
DEVOTED DUAL 009 NC (HMO D-SNP) Tier 1 - Preferred Generic — — — None
DEVOTED GIVEBACK 012 NC (HMO) Tier 1 - Preferred Generic — — — None
DEVOTED DUAL FULL 013 NC (HMO D-SNP) Tier 1 - Preferred Generic — — — None
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) Tier 1 - Preferred Generic — — — None
UHC Nursing Home Plan NC-F001 (PPO I-SNP) Tier 1 - Preferred Generic — — — None
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) Tier 1 - Preferred Generic — — — None
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) Tier 1 - Preferred Generic — — — None
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) Tier 1 - Preferred Generic — — — None
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) Tier 1 - Preferred Generic — — — None
Longevity Health Plan (HMO I-SNP) Tier 1 - Preferred Generic — — ✓ 30 per 30 days QL
Aetna Medicare Signature (PPO) Tier 1 - Preferred Generic — — ✓ 120 per 30 days QL
Aetna Medicare Enhanced (PPO) Tier 1 - Preferred Generic — — ✓ 120 per 30 days QL
Aetna Medicare Enhanced (PPO) Tier 1 - Preferred Generic — — ✓ 120 per 30 days QL
Aetna Medicare Signature Extra (PPO) Tier 1 - Preferred Generic — — ✓ 120 per 30 days QL
Aetna Medicare Signature (PPO) Tier 1 - Preferred Generic — — ✓ 120 per 30 days QL
Aetna Medicare Signature (PPO) Tier 1 - Preferred Generic — — ✓ 120 per 30 days QL
Aetna Medicare Signature Giveback (PPO) Tier 1 - Preferred Generic — — ✓ 120 per 30 days QL
Aetna Medicare Signature (PPO) Tier 1 - Preferred Generic — — ✓ 120 per 30 days QL
Humana Full Access H5525-034 (PPO) Tier 1 - Preferred Generic — — — None
HumanaChoice Giveback H5525-035 (PPO) Tier 1 - Preferred Generic — — — None
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) Tier 1 - Preferred Generic — — — None
HumanaChoice H5525-049 (PPO) Tier 1 - Preferred Generic — — — None
HumanaChoice H5525-050 (PPO) Tier 1 - Preferred Generic — — — None
HumanaChoice H5525-070 (PPO) Tier 1 - Preferred Generic — — — None
Humana Dual Select H5525-072 (PPO D-SNP) Tier 1 - Preferred Generic — — — None
HumanaChoice H5525-083 (PPO) Tier 1 - Preferred Generic — — — None
Erickson Advantage Signature (HMO-POS) Tier 1 - Preferred Generic — — — None
Erickson Advantage Guardian (HMO-POS I-SNP) Tier 1 - Preferred Generic — — — None
Erickson Advantage Champion (HMO-POS C-SNP) Tier 1 - Preferred Generic — — — None
Erickson Advantage Freedom (HMO-POS) Tier 1 - Preferred Generic — — — None
Erickson Advantage Liberty (HMO-POS) Tier 1 - Preferred Generic — — — None
PruittHealth Premier (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Liberty Medicare Advantage (HMO C-SNP) Tier 1 - Preferred Generic — — — None
Liberty Medicare Dual Plan (HMO D-SNP) Tier 1 - Preferred Generic — — — None
Humana Gold Plus H6622-025 (HMO-POS) Tier 1 - Preferred Generic — — — None
Humana Gold Plus H6622-026 (HMO-POS) Tier 1 - Preferred Generic — — — None
Humana Dual Select H6622-027 (HMO-POS D-SNP) Tier 1 - Preferred Generic — — — None
Humana Gold Plus H6622-057 (HMO-POS) Tier 1 - Preferred Generic — — — None
Humana Gold Plus H6622-060 (HMO-POS) Tier 1 - Preferred Generic — — — None
Humana Gold Plus H6622-061 (HMO-POS) Tier 1 - Preferred Generic — — — None
Alignment Health AVA (PPO) Tier 1 - Preferred Generic — — ✓ 45 per 30 days QL
HealthSpring True Choice (PPO) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Humana Gold Choice H8145-004 (PFFS) Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 1 - Preferred Generic — — — None
Healthy Blue + Medicare (HMO-POS D-SNP) Tier 1 - Preferred Generic — — ✓ 45 per 30 days QL
DEVOTED CHOICE 001 NC (PPO) Tier 1 - Preferred Generic — — — None
DEVOTED CHOICE GIVEBACK 002 NC (PPO) Tier 1 - Preferred Generic — — — None
DEVOTED CHOICE 003 NC (PPO) Tier 1 - Preferred Generic — — — None
DEVOTED CHOICE GIVEBACK 004 NC (PPO) Tier 1 - Preferred Generic — — — None
DEVOTED CHOICE 005 NC (PPO) Tier 1 - Preferred Generic — — — None
DEVOTED CHOICE GIVEBACK 006 NC (PPO) Tier 1 - Preferred Generic — — — None
DEVOTED CHOICE 008 NC (PPO) Tier 1 - Preferred Generic — — — None
DEVOTED CHOICE GIVEBACK 009 NC (PPO) Tier 1 - Preferred Generic — — — None
HealthSpring TotalCare (HMO D-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
HealthSpring Preferred (HMO) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
HealthSpring TotalCare Plus (HMO D-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
HealthSpring Preferred Select (HMO) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
HealthSpring Preferred Savings (HMO) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
HealthSpring Preferred Plus (HMO) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
HealthTeam Advantage Plan I (PPO) Tier 1 - Preferred Generic — — — None
HealthTeam Advantage Plan II (PPO) Tier 1 - Preferred Generic — — — None
HealthTeam Advantage Vitality Plan (PPO) Tier 1 - Preferred Generic — — — None
Aetna Medicare Signature (HMO) Tier 1 - Preferred Generic — — ✓ 120 per 30 days QL
Aetna Medicare Prime (HMO) Tier 1 - Preferred Generic — — ✓ 120 per 30 days QL
Aetna Medicare Signature Care (HMO) Tier 1 - Preferred Generic — — ✓ 120 per 30 days QL
Aetna Medicare Full Dual Care (HMO D-SNP) Tier 1 - Preferred Generic — — ✓ 120 per 30 days QL
Aetna Medicare Chronic Care (HMO C-SNP) Tier 1 - Preferred Generic — — ✓ 120 per 30 days QL
Aetna Medicare Enhanced (HMO) Tier 1 - Preferred Generic — — ✓ 120 per 30 days QL
Aetna Medicare Chronic Care Value (HMO C-SNP) Tier 1 - Preferred Generic — — ✓ 120 per 30 days QL
Blue Medicare PPO Enhanced (PPO) Tier 1 - Preferred Generic — — ✓ 45 per 30 days QL
Blue Medicare Essential Plus (HMO-POS) Tier 1 - Preferred Generic — — ✓ 45 per 30 days QL
Blue Medicare Enhanced (HMO-POS) Tier 1 - Preferred Generic — — ✓ 45 per 30 days QL
Blue Medicare Choice (HMO) Tier 1 - Preferred Generic — — ✓ 45 per 30 days QL
Blue Medicare Essential (HMO) Tier 1 - Preferred Generic — — ✓ 45 per 30 days QL
Experience Health Medicare Advantage (HMO) Tier 1 - Preferred Generic — — ✓ 45 per 30 days QL
Wellcare Simple (HMO-POS) Tier 1 - Preferred Generic — — — None
Wellcare Dual Access (HMO-POS D-SNP) Tier 1 - Preferred Generic — — — None
Wellcare Dual Reserve (HMO-POS D-SNP) Tier 1 - Preferred Generic — — — None
Wellcare Dual Liberty (HMO-POS D-SNP) Tier 1 - Preferred Generic — — — None
NHC Advantage (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Senior Care (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Advantage Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Community Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Essential Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Troy Medicare (HMO) Tier 1 - Preferred Generic — — — None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 1 - Preferred Generic — — — None
HumanaChoice Giveback H5216-017 (PPO) Tier 1 - Preferred Generic — — — None
HumanaChoice H5216-211 (PPO) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0022 (HMO-POS) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0007 (HMO-POS) Tier 1 - Preferred Generic — — — None
UHC Dual Complete NC-D001 (HMO-POS D-SNP) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0008 (HMO-POS) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0009 (HMO-POS) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0011 (HMO-POS) Tier 1 - Preferred Generic — — — None
Humana Gold Plus H1036-233 (HMO-POS) Tier 1 - Preferred Generic — — — None
Humana Dual Select H1036-307 (HMO D-SNP) Tier 1 - Preferred Generic — — — None
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) Tier 1 - Preferred Generic — — — None
Humana Gold Plus Giveback H1036-318 (HMO-POS) Tier 1 - Preferred Generic — — — None
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) Tier 1 - Preferred Generic — — — None
Humana Gold Plus H1036-335 (HMO-POS) Tier 1 - Preferred Generic — — — None
UHC Dual Complete NC-S001 (PPO D-SNP) Tier 1 - Preferred Generic — — — None
UHC Dual Complete NC-S2 (PPO D-SNP) Tier 1 - Preferred Generic — — — None
Wellcare Simple Open (PPO) Tier 1 - Preferred Generic — — — None
Wellcare Dual Liberty Open (PPO D-SNP) Tier 1 - Preferred Generic — — — None
Wellcare Assist Open (PPO) Tier 1 - Preferred Generic — — — None
Wellcare Giveback Open (PPO) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage Access from UHC NC-23 (PPO) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0001 (PPO) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0004 (PPO) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0016 (PPO) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0017 (PPO) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0019 (PPO) Tier 1 - Preferred Generic — — — None
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) Tier 1 - Preferred Generic — — — None
Aetna Medicare Signature (HMO) Tier 1 - Preferred Generic — — ✓ 120 per 30 days QL
Aetna Medicare Dual (HMO D-SNP) Tier 1 - Preferred Generic — — ✓ 120 per 30 days QL
NHC Advantage (HMO I-SNP)
via CITALOPRAM HBR 		Tier 1 - Preferred Generic — — ✓ 600 per 30 days QL
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via CITALOPRAM HBR 		Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Community Plan (HMO I-SNP)
via CITALOPRAM HBR 		Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via CITALOPRAM HBR 		Tier 1 - Preferred Generic — — — None
Aetna Medicare Value Plus (HMO) Tier 1 - Preferred Generic — — ✓ 120 per 30 days QL
Humana Gold Plus H1036-137 (HMO-POS) Tier 1 - Preferred Generic — — — None
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas VIP Care (HMO D-SNP)
via CITALOPRAM HBR 		Tier 2 - Generic — — — None
Liberty Medicare Advantage (HMO C-SNP)
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Aetna Medicare Signature (PPO)
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Aetna Medicare Signature Giveback (PPO)
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Aetna Medicare Signature (HMO)
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Aetna Medicare Dual (HMO D-SNP)
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Aetna Medicare Signature (HMO)
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Aetna Medicare Value Plus (HMO)
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Aetna Medicare Prime (HMO)
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Aetna Medicare Signature Care (HMO)
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Aetna Medicare Full Dual Care (HMO D-SNP)
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Aetna Medicare Chronic Care (HMO C-SNP)
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Aetna Medicare Enhanced (HMO)
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Aetna Medicare Chronic Care Value (HMO C-SNP)
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Aetna Medicare Enhanced (PPO)
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Wellcare Simple Open (PPO)
via CITALOPRAM HBR 		Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO)
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Aetna Medicare Signature (PPO)
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Wellcare Giveback Open (PPO)
via CITALOPRAM HBR 		Tier 2 - Generic — — — None
Aetna Medicare Enhanced (PPO)
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Aetna Medicare Signature (PPO)
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Troy Medicare (HMO)
via CITALOPRAM HBR 		Tier 2 - Generic — — — None
Senior Care (HMO I-SNP)
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via CITALOPRAM HBR 		Tier 2 - Generic — — — None
Wellcare Simple (HMO-POS)
via CITALOPRAM HBR 		Tier 2 - Generic — — — None
Aetna Medicare Signature Extra (PPO)
via CITALOPRAM HBR 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Humana Gold Choice H8145-004 (PFFS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H1036-137 (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H1036-233 (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Humana Dual Select H1036-307 (HMO D-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H1036-335 (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-S001 (PPO D-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-S2 (PPO D-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0001 (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0004 (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0016 (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0017 (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0019 (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Blue Medicare PPO Enhanced (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — ✓ 600 per 30 days QL
Blue Medicare Essential Plus (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — ✓ 600 per 30 days QL
Blue Medicare Enhanced (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — ✓ 600 per 30 days QL
Blue Medicare Choice (HMO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — ✓ 600 per 30 days QL
Blue Medicare Essential (HMO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — ✓ 600 per 30 days QL
Experience Health Medicare Advantage (HMO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — ✓ 600 per 30 days QL
HumanaChoice Giveback H5216-017 (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
HumanaChoice H5216-211 (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
UHC Complete Care NC-25 (HMO-POS C-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
UHC Complete Care NC-27 (HMO-POS C-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
UHC Complete Care NC-28 (HMO-POS C-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Alignment Health Platinum (HMO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — ✓ 600 per 30 days QL
Alignment Health NC Duals (HMO-POS D-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — ✓ 600 per 30 days QL
Alignment Health smartHMO (HMO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — ✓ 600 per 30 days QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — ✓ 600 per 30 days QL
Alignment Health Platinum Select (HMO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — ✓ 600 per 30 days QL
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — ✓ 600 per 30 days QL
DEVOTED CORE 001 NC (HMO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
DEVOTED GIVEBACK 002 NC (HMO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
DEVOTED DUAL 009 NC (HMO D-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
DEVOTED GIVEBACK 012 NC (HMO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Humana Full Access H5525-034 (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
HumanaChoice Giveback H5525-035 (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
HumanaChoice H5525-049 (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
HumanaChoice H5525-050 (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
HumanaChoice H5525-070 (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Humana Dual Select H5525-072 (PPO D-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
HumanaChoice H5525-083 (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Signature (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Guardian (HMO-POS I-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Champion (HMO-POS C-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Freedom (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Liberty (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-025 (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-026 (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-057 (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-060 (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-061 (HMO-POS)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Alignment Health AVA (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — ✓ 600 per 30 days QL
HealthSpring True Choice (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
Healthy Blue + Medicare (HMO-POS D-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — ✓ 600 per 30 days QL
DEVOTED CHOICE 001 NC (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 003 NC (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 005 NC (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 008 NC (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
HealthSpring TotalCare (HMO D-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
HealthSpring Preferred (HMO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
HealthSpring TotalCare Plus (HMO D-SNP)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Select (HMO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Savings (HMO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Plus (HMO)
via CITALOPRAM HBR 		Tier 3 - Preferred Brand — — — None
HealthTeam Advantage Vitality Plan (PPO)
via CITALOPRAM HBR 		Tier 4 - Non-Preferred — — — None
HealthTeam Advantage Plan II (PPO)
via CITALOPRAM HBR 		Tier 4 - Non-Preferred — — — None
HealthTeam Advantage Plan I (PPO)
via CITALOPRAM HBR 		Tier 4 - Non-Preferred — — — None
Wellcare Dual Liberty (HMO-POS D-SNP)
via CITALOPRAM HBR 		Tier 4 - Non-Preferred — — — None
Wellcare Dual Reserve (HMO-POS D-SNP)
via CITALOPRAM HBR 		Tier 4 - Non-Preferred — — — None
Wellcare Dual Access (HMO-POS D-SNP)
via CITALOPRAM HBR 		Tier 4 - Non-Preferred — — — None
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via CITALOPRAM HBR 		Tier 4 - Non-Preferred — — — None
Wellcare Assist Open (PPO)
via CITALOPRAM HBR 		Tier 4 - Non-Preferred — — — None
Wellcare Dual Liberty Open (PPO D-SNP)
via CITALOPRAM HBR 		Tier 4 - Non-Preferred — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 7 hours, 22 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026 Tier 1 - Preferred Generic — — — None
NC State Health Plan - 70/30 Standard PPO 2026 Tier 1 - Preferred Generic — — — None
NC State Health Plan - 80/20 Plus PPO 2026 Tier 1 - Preferred Generic — — — None
Source: Excel (XLSX)  ·  Formulary date: Jul 31, 2026  ·  Checked: 7 hours, 22 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026 Tier 1 - Basic Core Formulary ✓ — — PA
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